Boston, November 6, 2024—Healthcare technology innovator

enGen and Abacus Insights, the leader in data usability for U.S. payers, today unveiled their collaboration on next-generation platforms and solutions that enable health plans to increase efficiency, reduce costs, improve member care, meet regulatory mandates and realize other enterprise priorities.

enGen, a wholly owned subsidiary of Highmark Health, is embedding Abacus Insights’ data transformation platform, data models and data connectors into its world-class solutions for payer administration and analytics serving more than 50 Blues and other health plans with more than 20 million members. The combined capabilities create products with usable data for enGen clients that is real-time, accessible on demand, and interoperable for all users including in-house teams, providers, payers and members.

“Abacus Insights and its data usability ecosystem is a proven value accelerator at scale. Our collaboration will enable enGen to take our market-leading suite of solutions to a new level of effectiveness, enhancing and expediting strategic value for our payer clients and their members,” said Mick Malec, enGen’s enterprise technology and operations officer and chief executive officer.

Initial joint solutions include:

• CMS-0057 Interoperability Solution. This new enGen product addresses the critical requirements of the CMS-0057 interoperability mandate, covering payer-to-payer, provider-to-payer, and e-prior auth APIs, to accelerate compliance ahead of the January 1, 2026 and January 1, 2027 deadlines and at the lowest total cost of ownership for payers. The turnkey solution works with all cloud and non-cloud architectures and various administrative enGen and non-enGen platforms used by payers. It is available as a standalone option or integrated with enGen’s Predictal prior authorization/utilization management (UM) solution.
• Self-service usable data access for all enGen platforms and solutions. This new capability enables business users to easily move claims, membership and other key business process data from enGen solutions to the payer’s BI tools and other systems with minimal IT intervention. The data can be automatically distributed to any payer system, including on-premise, various clouds, and Databricks- and Snowflake-driven architectures.
• Streamlined Predictal integration and rapid value realization. By integrating Abacus Insights’ pre-configured data connectors with enGen’s industry-leading Predictal solution for utilization and care management, the partnership offers a simplified and accelerated onboarding path. Health plans can realize value quickly from various Predictal modules such as Automated Authorization Hub and Next Gen Analytics. The enhanced solution seamlessly integrates with 120+ common payer systems.

“We are excited to collaborate with enGen to advance their market-leading solutions, improving ease of use and adding capabilities to enhance performance for all payers,” said Minal Patel, MD, CEO and co-founder of Abacus Insights. “By combining our complementary strengths and shared payer industry expertise and experience, we are looking forward to driving greater success and outcomes for all healthcare stakeholders.”

About enGen

enGen is a wholly owned healthtech subsidiary of Highmark Health. Founded in 2014 and formerly known as HM Health Solutions, enGen has built a complete healthtech platform that helps plans and their members operate at their highest levels as well as stand-alone solutions to meet any client’s needs. Powered by a dynamic ecosystem of smart automation and technology, our expert combination of people, process, and technology helps to support and streamline complex operations for health plans and their provider partners.

About Abacus Insights

Abacus Insights is a healthcare technology leader with the only data transformation platform and data solutions built specifically for health plans. By setting the new standard of payer data to usability, Abacus Insights gives payers a new level of control and flexibility to support analytics and operational use cases. Managing data for 23+ million members, Abacus Insights partners with payers to deliver scalable solutions that drive strategic initiatives, control costs, and improve member lives and experiences.

Media Contact:

Lois Padovani
For Abacus Insights

773.501.8744

Kaitlyn Joyce
For enGen
412.983.1559